This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Friday, May 03, 2013

Here Are Some Very Interesting Views On Health Information Sharing.

EHI Primary Care’s columnist is not sure about giving patients online access to their notes; although he has lots of other ideas for helping them digitally.

16 April 2013

The government is having another push on making sure that patients can get access to their GP-held records. In fact, one of the few, definite, commitments that has made on the NHS IT front is that patients should have online access by 2015.

Yet, I’m not convinced that this is something that people really want; even though there may be some benefits when we get around to implementing the idea that have not been discussed yet.

Why aren’t doctors keen?

Most of the doctors I speak with don’t have an intrinsic problem with patients seeing their notes; they just don’t feel it’s a high priority or that it’s going to help more than it hinders.

Their main fear is that they will have to spend time dealing with the minority that hassle them about trivial inaccuracies: “I said the pain was six hours not five”; “the scar is two centimetres above my left knee not three.”

In the same vein, a number worry that some patients will want every medical term explaining. However, I know of companies that are trying to make front-ends to the patient record that make understanding easier, while providing links to existing sources of further information.

The other big concern is a potential loss of confidentiality. Let’s say you are a beaten or abused wife, daughter or even a son; or let’s just say you aren’t in a happy relationship.

You can manage to get to the GP when your abuser is out. At the moment, what you say to the GP is confidential. You can discuss your unhappiness, contraception, depression, treatment, anything you need to deal with.

In a world where online access is standard, are you really going to be able to stop that abusive person accessing your record to see what you are saying about them? Are you going to be able to withhold your password so they can’t see your records?

Now, I’m not saying that GPs are the only line of defence against abuse. But, potentially, some of the most vulnerable patients will find that, in practice, their health records are no longer private. Is this right?

What actually do they need to see?

Some doctors I've spoken to worry that the notes they keep are working notes; they are used as an aide memoir and action plan and aren’t written to be seen by others. At worst, they might actively scare or upset a patient.

An example might be – “looks stressed: fidgety, staring, unkempt - ?thyroid ?stress ?alcohol.” If the problem turns out to be a thyroid disorder, is the patient going to be offended by the query about their being a potential alcoholic?

They might be, but perhaps patients just need to see the answers to their sums, not the workings out. In that case, the online record could show just the diagnoses and the treatments, not the roadmap to them. Would access to a summary fit with the NHS transparency agenda? Would it keep patients happy?

If ever there was a coherent discussion of what needs to be thought about when deciding what information should be shared with the patient this is it.

I have always wondered just how a doctor is meant to document impressions and thoughts before reaching conclusions which may then be discussed with a patient, given especially the value of this documentation in explaining to other clinicians and courts what thought processes were applied in reaching a final professional view.

Dr Paul does a good job of covering the issue and offering some suggestions as to what might be done.